As with many cases of nonspecific low back pain, even when there’s a known cause (car accident), tests are negative and no known anatomical reason exists for the pain that continues past the time of healing. Many patients like you who find themselves in this situation expect a medical doctor somewhere to figure out what is wrong and fix it. They have become weak and deconditioned. Their quality of life has plummeted. They feel they have nowhere else to go.
If that’s your situation, then it’s time to take action. Many people with chronic pain have found out that they can learn to manage the pain, reduce the sense of suffering, and understand the pain, rather than fear it. But it takes a multidisciplinary program of pain management, physical therapy, cognitive behavioral therapy, counseling, and activity — not just one of these modalities at a time, but a mix of several (sometimes all) of them.
Entering a comprehensive pain-management program can give you the tools needed to get back control of your life and improve your quality of life. You may not get rid of the pain, but it will no longer dictate what you can and can’t do. You can learn how to live with your pain and remain active. It is possible to change from being a passive patient waiting for a cure that may never happen to becoming a person with improved quality of life and a desire to continue learning in spite of the pain.
Keep in mind there are certain risk factors that contribute to chronic pain. Trauma of any kind can play a role. A past (or current) history of physical or sexual abuse or trauma is a key factor. It’s estimated that as many as half of all patients with chronic back pain have some type of abuse history.
Although the pain itself might not be the result of posttraumatic stress disorder (PTSD; also known as posttraumatic stress syndrome or PTSS), the level of pain intensity and chronic duration seem to be linked with PTSD/PTSS. PTSD/PTSS seems to affect severity of symptoms, level of disability, and depth of depression. One other psychologic factor that seems to be part of the picture with chronic pain is pain catastrophizing.
Pain catastrophizing refers to a negative view of the pain experience. It is exaggerated or blown out of proportion. Sometimes it refers to a patient who actually has pain already. In other cases the person isn’t even in pain yet — he or she is still just anticipating it might happen. A person who tends to catastrophize sees things as worse than they really are. Studies show that without intervention these behaviors can lead to chronic pain and disability over time. Catastrophizing or expecting the worst to happen increases pain. Catastrophizing boosts anxiety and worry. These negative emotions stimulate neural systems that produce increased sensitivity to pain. It can become a vicious cycle.
It may be time to take stock of your situation. Review your own risk factors. Put aside thoughts that nothing will help — you’ve tried it all. Start over by seeking a multidisciplinary approach and set your course for improving and maintaining the best quality of life despite the pain. Many people have done this successfully and can help you get started as well.